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OBJECTIVE: We aimed to compare the image quality and focal lesion detection ability of hepatobiliary phase (HBP) images obtained using compressed sensing (CS) and controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) in patients with liver cirrhosis. MATERIALS AND METHODS: We retrospectively included 244 gadoxetic acid-enhanced liver MRI from 244 patients with cirrhosis obtained by two HBP images using CS and CAIPIRINHA from July 2020 to December 2020. The optimized resolution and scan time for CS-HBP and CAIPIRINHA-HBP were 0.9 × 0.9 × 1.5 mm3 and 15 s and 1.3 × 1.3 × 3 mm3 and 16 s, respectively. We compared the image quality between the two sets of images in 244 patients and focal lesion (n = 294) analyses for 112 patients. RESULTS: CS-HBP showed comparable overall image quality (3.7 ± 0.9 vs. 3.6 ± 0.8, p = 0.680), superior liver edge sharpness (3.9 ± 0.6 vs. 3.6 ± 0.5, p < 0.001), and fewer respiratory motion artifacts (4.0 ± 0.7 vs. 3.8 ± 0.5, p < 0.001), but higher non-respiratory artifacts (3.4 ± 0.7 vs. 3.6 ± 0.6, p < 0.001) and subjective image noise (3.5 ± 0.8 vs. 3.6 ± 0.7, p = 0.014) than CAIPIRINHA-HBP. CS-HBP showed a higher signal-to-noise ratio in the liver than CAIPIRINHA-HBP (20.9 ± 9.0 vs. 18.9 ± 7.1, p = 0.008). The pooled sensitivity, specificity, and AUC were 90.0%, 77.5%, and 0.84 for CS-HBP and 73.5%, 82.4%, and 0.78 for CAIPIRINHA-HBP, respectively. CONCLUSIONS: CS-HBP showed better focal lesion detection ability, comparable overall image quality, and fewer respiratory motion artifacts, but higher non-respiratory artifacts and noise compared to CAIPIRINHA-HBP. Thus, CS-HBP could be recommended for liver MRI in patients with cirrhosis to improve diagnostic performance. CLINICAL RELEVANCE STATEMENT: Thin-slice CS-HBP may be useful for detecting sub-centimeter hepatocellular carcinoma in cirrhotic patients with Child-Pugh classification A while maintaining comparable subjective image quality. KEY POINTS: ⢠Compared with controlled aliasing in parallel imaging results in higher acceleration, compressed sensing hepatobiliary phase yielded thinner slices and shorter scan time at a higher accelerating factor. ⢠Compressed sensing hepatobiliary phase showed comparable overall image quality, superior liver edge sharpness, and fewer respiratory motion artifacts, but higher non-respiratory artifacts and subjective image noise than controlled aliasing in parallel imaging results in higher acceleration-hepatobiliary phase. ⢠Compressed sensing hepatobiliary phase can detect sub-centimeter hepatocellular carcinoma in cirrhotic patients with Child-Pugh classification A.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Medios de Contraste , Estudios Retrospectivos , Imagenología Tridimensional/métodos , Gadolinio DTPA , Imagen por Resonancia Magnética/métodos , Aceleración , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico por imagen , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Artefactos , Aumento de la Imagen/métodosRESUMEN
OBJECTIVES: To evaluate the recall rate and performance of free-breathing T1W dynamic imaging in patients who underwent gadoxetic acid-enhanced liver MRI. METHODS: We retrospectively reviewed patients who underwent free-breathing dynamic T1WI liver MRI using Cartesian (XD-VIBE) or self-gated radial (SG-GRASP) sequences at two institutions. Four radiologists independently reviewed the overall image quality, streak, and motion artifacts for precontrast, arterial, and portal venous phases on a 4-point scale. Hepatic observations were annotated and assessed according to LI-RADS v2018. RESULTS: In total, 360 patients were included (XD-VIBE [n = 253], SG-GRASP [n = 107]). The overall image quality of free-breathing T1WI was 3.4 ± 0.4, 3.2 ± 0.4, and 3.5 ± 0.4 for precontrast, arterial, and portal venous phases, respectively. The actual recall rate was 0.6% (2/360). The SG-GRASP group showed fewer motion artifacts and more streak artifacts than the XD-VIBE group in all phases (p < 0.001 for all). The overall image quality was not significantly different between the two sequences in arterial (3.2 ± 0.4 in both, p = 0.607) and portal venous phases (3.5 ± 0.4 in XD-VIBE, 3.4 ± 0.4 in SG-GRASP, p = 0.214). Two sequences did not show significant differences in the lesion detection rate (figure of merit, FOM: 0.67 vs. 0.68, p = 0.876) or diagnostic performance for hepatocellular carcinoma (FOM: 0.55 vs. 0.62, p = 0.105). CONCLUSIONS: Both XD-VIBE and SG-GRASP provided sufficient image quality for patients at risk of developing motion artifacts, without significant differences in image quality or the lesion detection rate between sequences. KEY POINTS: ⢠The overall image quality of free-breathing T1-weighted images using Cartesian or radial sequences was 3.4 ± 0.4, 3.2 ± 0.4, and 3.5 ± 0.4 for precontrast, arterial, and portal venous phases, respectively. ⢠Only 0.3% (1/360) had undiagnostic exams and the actual recall rate was 0.6% (2/360) in patients who underwent free-breathing dynamic T1WI. ⢠The overall lesion detection rate was 0.67 without a significant difference between Cartesian and radial sequences (figure of merit: 0.67 vs. 0.68, respectively, p = 0.876).
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Artefactos , Estudios Retrospectivos , Neoplasias Hepáticas/diagnóstico por imagen , Medios de Contraste/farmacología , Imagen por Resonancia Magnética/métodos , Aumento de la Imagen/métodosRESUMEN
OBJECTIVE: To evaluate and compare the diagnostic performance of the updated HCC guidelines using gadoxetic acid-enhanced MRI. METHODS: In this study, patients at risk of HCC who underwent gadoxetic acid-enhanced MRI following US/CT surveillance were retrospectively recruited from 3 centers. Three radiologists independently evaluated hepatic nodule imaging features relevant to the diagnostic criteria outlined in each guideline. Per-lesion sensitivity, specificity, and accuracy were compared between guidelines using logistic regression with a generalized estimating equation. Inter-observer agreements on imaging features were determined using Fless κ statistics. RESULTS: Altogether, 447 nodules (310 HCCs, 20 combined hepatocellular-cholangiocarcinomas, 2 cholangiocarcinomas, and 115 benign entities) measuring 1-3 cm from 386 patients were assessed. The KLCA-NCC and APASL guidelines showed the highest sensitivity (82.3-90.6%, p < .001) and accuracy (83.9-88.6%) among the five guidelines. The OPTN/UNOS guideline showed the highest specificity (94.9-97.1%), followed by the AASLD/LI-RADS, EASL, KLCA-NCC, and APASL guidelines, with significant difference only with the APASL guideline. The diagnostic performance of the updated AASLD/LI-RADS and EASL guidelines and of the KLCA-NCC and APASL guidelines was comparable (p > .05). Inter-observer agreement was substantial to almost perfect (κ = 0.73-0.87). CONCLUSIONS: For the diagnosis of HCC using gadoxetic acid-enhanced MRI, the KLCA-NCC and APASL guidelines showed the highest sensitivity and accuracy. The OPTN/UNOS guideline showed the highest specificity. Acknowledging their relative strengths and weaknesses could help adapt the diagnostic criteria according to the clinical context. KEY POINTS: ⢠APASL and KLCA-NCC provided significantly the highest sensitivity and accuracy, followed by AASLD/LI-RADS and EASL in an endemic area for hepatitis B. ⢠OPTN/UNOS showed the highest specificity, followed by AASLD/LI-RADS, EASL, KLCA-NCC, and APASL guidelines, with significant difference only with APASL. ⢠Broadened definition of arterial hyperenhancement, washout, and the size of the lesion eligible to apply diagnostic criteria may improve the diagnostic performance for HCC in an endemic area for hepatitis B.
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Neoplasias de los Conductos Biliares , Carcinoma Hepatocelular , Neoplasias Hepáticas , Conductos Biliares Intrahepáticos , Carcinoma Hepatocelular/diagnóstico por imagen , Medios de Contraste , Gadolinio DTPA , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Imagen por Resonancia Magnética , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To compare the diagnostic performance of abbreviated MRI (AMRI) combined with multiphasic CT (mCT) with that of full-sequence gadoxetic acid-enhanced MRI (EOB-MRI) in a hepatocellular carcinoma (HCC)-screening cohort METHODS: Consecutive patients at risk of HCC who underwent EOB-MRI and mCT within 3 months for evaluation of new 0.5-3-cm hepatic observations were retrospectively recruited from 3 centers. An AMRI protocol comprising hepatobiliary phase, T2- and diffusion-weighted imaging, and dual-echo sequence was reconstituted from EOB-MRI. Two radiologists independently reviewed each observation in AMRI plus mCT (set 1) and EOB-MRI (set 2) per LI-RADS v2018. Per-lesion sensitivity, accuracy, and positive predictive value (PPV) for HCC were calculated and compared between image sets. RESULTS: In 267 patients, 306 histologically confirmed observations (280 HCCs, 20 combined hepatocellular-cholangiocarcinomas, 1 cholangiocarcinoma, and 5 benignities) were assessed. Set 1 yielded higher sensitivity (96.4% vs. 92.9%, p = 0.013) and comparable accuracy (91.2% vs. 87.6%) and PPV (94.1% vs. 93.5%) to set 2 using LI-RADS category (LR)-4/5 criteria. The sets showed comparable sensitivity (66.4% vs. 70.4%), accuracy (67.7% vs. 70.6%), and PPV (97.4% vs. 96.6%) using LR-5 criteria. A similar substantial number of non-HCC malignancies were categorized as LR-4 or LR-5, as was the number of HCCs categorized as LR-M in both sets. CONCLUSIONS: AMRI combined with mCT showed diagnostic performance similar or superior to that of EOB-MRI for HCC diagnosis using LI-RADS. Therefore, mCT holds potential as a sequential examination for HCC diagnosis in AMRI-detected hepatic observation in patients at risk of HCC. KEY POINTS: ⢠AMRI plus multiphasic CT showed comparable accuracy (91.2%) and PPV (94.1%) to full-sequence gadoxetic acid-enhanced MRI using LR-4/5 criteria. ⢠AMRI plus multiphasic CT was significantly more sensitive than full-sequence gadoxetic acid-enhanced MRI (96.4% vs. 92.9%) using LR-4/5 criteria. ⢠Multiphasic CT is a potential sequential modality for HCC diagnosis after AMRI.
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Algoritmos , Carcinoma Hepatocelular/diagnóstico , Imagen de Difusión por Resonancia Magnética/métodos , Neoplasias Hepáticas/diagnóstico , Hígado/diagnóstico por imagen , Tomografía Computarizada Multidetector/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: Patients with renal stones receive multiple computed tomography (CT) examinations. We investigated whether submillisievert (sub-mSv) CT for stone detection could reduce radiation dose at exposure levels comparable to kidney, ureter, and bladder (KUB) radiography. PURPOSE: To evaluate the radiation dose exposure, diagnostic performance, and image quality of sub-mSv non-contrast CT using advanced modelled iterative reconstruction algorithm with spectral filtration for the detection of urolithiasis. MATERIAL AND METHODS: A total of 145 consecutive patients underwent non-contrast CT using a third-generation dual-source scanner to obtain two datasets, i.e. 16.7% (sub-mSv CT, tube detector A) and 100% (standard-dose CT, combination of tube detector A and B) tube loads with spectral filtration. The performance of sub-mSv CT for the detection of stones was analyzed by two readers and compared with that of standard-dose CT. Image quality was measured subjectively and objectively. RESULTS: In total, 171 stones were detected in 79 patients. The mean effective radiation doses of sub-mSv CT was 0.3 mSv. The sensitivity and specificity values for diagnosis of stones measuring ≥3 mm was 95.1% and 100% for sub-mSv CT. The sensitivity and specificity for all stone detection was 74.9% and 97.8%, respectivey, for sub-mSv CT. The image quality was lower for sub-mSv CT than for standard-dose CT (P < 0.01). CONCLUSION: Sub-mSv CT can be achieved with radiation doses close to KUB radiography. Sub-mSv CT with spectral filtration can be used to detect stones measuring ≥3 mm and be used as a follow-up imaging modality as an alternative to KUB radiography.
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Tomografía Computarizada por Rayos X/métodos , Urolitiasis/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Dosis de Radiación , Exposición a la Radiación , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is a rare hereditary kidney cancer syndrome in which affected individuals are at risk of skin and uterine leiomyomatosis and kidney cancer. HLRCC-associated kidney cancer is a lethal disease with a highly aggressive behavior, and there is no standard treatment option for metastatic disease. CASE PRESENTATION: Here, we report a 29-year-old patient with a locally advanced HLRCC-assiciated RCC. He was administrated temsirolimus initially, then underwent surgical removal of kidney, retroperitoneal lymph nodes, inferior vena cava and tumor thrombi. Unfortunately, multiple liver metastases were confirmed 1 month after surgery, so axitinib was given but failed immediately. We tried bevacizumab plus erlotinib, which achieved long-term good response lasting more than 18 months. He is alive with disease and maintains bevacizumab plus erlotinib treatment. CONCLUSION: The promising results obtained in this patient suggest that combined bevacizumab plus erlotinib may offer a valid treatment option for advanced HLRCC-associated kidney cancer, even after failures of mTOR inhibitor and/or VEGFR TKI based therapies.
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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Bevacizumab/administración & dosificación , Carcinoma de Células Renales/tratamiento farmacológico , Clorhidrato de Erlotinib/administración & dosificación , Neoplasias Renales/tratamiento farmacológico , Leiomiomatosis/tratamiento farmacológico , Neoplasias Primarias Múltiples/tratamiento farmacológico , Síndromes Neoplásicos Hereditarios/tratamiento farmacológico , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Uterinas/tratamiento farmacológico , Adulto , Axitinib/uso terapéutico , Humanos , Masculino , Sirolimus/análogos & derivados , Sirolimus/uso terapéutico , Neoplasias Cutáneas/secundario , Factores de Tiempo , Insuficiencia del Tratamiento , Neoplasias Uterinas/secundarioRESUMEN
OBJECTIVES: To document the level of interobserver agreement and compare the diagnostic performances of emergency physicians and radiologists at interpreting low radiation CT images of acute appendicitis in adolescents and young adults. METHODS: One hundred and seven adolescents and young adult patients (aged 15 to 44years) that underwent 2-mSv low-dose CT for suspected acute appendicitis between June and December in 2013 were enrolled in this retrospective study. Three emergency physicians and three radiologists with different experiences of low-dose CT independently reviewed CT images. These six physicians rated the likelihood of acute appendicitis using a 5-point Likert scale. We calculated interobserver agreement and compared the diagnostic performances between emergency physicians and radiologists. And diagnostic confidence was also assessed using the likelihood of acute appendicitis. RESULTS: Acute appendicitis was pathologically confirmed in 42 patients (39%); the remaining 65 patients were considered not to have appendicitis. Fleiss' Kappa for reliability of agreement between emergency physicians and radiologists for the diagnosis of acute appendicitis was 0.720 (95% confidence intervals (CI), 0.685-0.726). Pooled areas under the receiver operating characteristics curve (AUC) for a diagnosis of appendicitis were 0.904 and 0.944 for emergency physicians and radiologists, respectively, and these AUC values were not significantly different (95% confidence interval, -0.087, 0.007; p=0.0855). CONCLUSION: The emergency physicians and radiologists showed good interobserver agreement and comparable diagnostic performances for appendicitis in adolescents and adults using low-dose CT images. Low-dose CT could be a useful tool for the diagnosis of appendicitis by emergency physicians.
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Apendicitis/diagnóstico por imagen , Apéndice/patología , Servicio de Urgencia en Hospital , Tomografía Computarizada por Rayos X/métodos , Enfermedad Aguda , Adolescente , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Curva ROC , Dosis de Radiación , Ensayos Clínicos Controlados Aleatorios como Asunto , Reproducibilidad de los Resultados , República de Corea , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVES: We investigated the prognostic significance of changes in primary tumor volume and serum squamous cell carcinoma antigen (SCC-ag) levels during radiation therapy (RT) in patients with cervical cancer. METHODS: We conducted a review of 40 patients treated with RT. All patients received external beam RT and intracavitary brachytherapy. The primary tumor volume and squamous cell carcinoma antigen levels were measured pre-RT and mid-RT. Overall survival (OS) and progression free survival (PFS) were estimated, and possible prognostic factors for survival were analyzed. RESULTS: The correlation coefficient between primary tumor volume reduction rate (pTVRR) and serum squamous cell carcinoma antigen reduction rate in all patients was 0.550 (P < 0.001). In univariate analysis, stage more than II (P <0.001), pre-RT pTV of 55 cm or more (P = 0.05), mid-RT tumor size of 4 cm or more (P = 0.004), and pTVRR of 90% or less (P = 0.031) were significant unfavorable prognostic factors for PFS, whereas stage (P = 0.009) was the only significant prognostic factor for OS. Multivariable analysis revealed that none of these factors were independently associated with PFS or OS. CONCLUSIONS: There was a significant correlation between pTVRR and squamous cell carcinoma antigen reduction rate. Our findings indicate that the tumor parameters such as pre-RT pTV, mid-RT tumor size, and pTVRR are associated with PFS in women with cervical cancer.
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Antígenos de Neoplasias/sangre , Biomarcadores de Tumor/sangre , Serpinas/sangre , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Braquiterapia , Supervivencia sin Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Neoplasias del Cuello Uterino/sangre , Neoplasias del Cuello Uterino/patologíaAsunto(s)
Dolor Abdominal/diagnóstico por imagen , Dosis de Radiación , Radiografía Abdominal/métodos , Tomografía Computarizada por Rayos X/métodos , Abdomen/diagnóstico por imagen , Enfermedad Aguda , Femenino , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Masculino , Persona de Mediana Edad , Pelvis/diagnóstico por imagen , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
Malignant lymphoma typically presents with homogeneous enhancement of enlarged lymph nodes without internal necrotic or cystic changes on multiphasic CT, which can be suspected without invasive diagnostic methods. However, some subtypes of malignant lymphoma show atypical imaging features, which makes diagnosis challenging for radiologists. Moreover, there are several lymphoma-mimicking diseases in current clinical practice, including leukemia, viral infections in immunocompromised patients, and primary or metastatic cancer. The ability of diagnostic processes to distinguish malignant lymphoma from mimicking diseases is necessary to establish effective management strategies for initial radiological examinations. Therefore, this study aimed to discuss the typical and atypical imaging features of malignant lymphoma as well as mimicking diseases and discuss important diagnostic clues that can help narrow down the differential diagnosis.
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BACKGROUND: Transvenous access for endovascular treatment of dysfunctional hemodialysis (HD) access can be technically difficult in the retrograde selection of the HD access. This study aims to evaluate the efficacy of primary antegrade wire guidance in assisting transvenous access. METHODS: A total of 41 transvenous access procedures (17 with and 24 without antegrade wire guidance), performed between March 2019 and February 2023, were included. Electronic medical records and procedural images were retrospectively reviewed. RESULTS: Of the 41 procedures, 17 performed primary antegrade wire guidance (group A) and 24 did not (group B). The technical success rate was 100% in group A and 95.8% (23/24) in group B. The mean retrograde selection time was 16.7 min in group A, whereas it was 30.9 min in group B (p = 0.014). Additional intraprocedural fistulography was not performed in group A, while it was performed at an average of 1.5 times (range: 0-4) in group B (p = 0.001). One patient in group B experienced venous dissection as a minor complication; however, no major complications were observed in either of the groups. CONCLUSIONS: Using primary antegrade wire guidance in endovascular treatment of dysfunctional HD access via alternative transvenous access is safe and time-saving.
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Hepatocellular carcinoma (HCC) can be diagnosed noninvasively on multiphasic CT and MRI based on its distinctive imaging findings. These features include arterial phase hyperenhancement and washout on portal or delayed phase images. However, radiologists face significant diagnostic challenges because some HCCs exhibit atypical imaging characteristics. In addition to many HCC-mimicking lesions, such as arterioportal shunts, combined HCC-cholangiocarcinoma, intrahepatic cholangiocarcinoma, and hemangioma present a challenge for radiologists in actual clinical practice. The ability to distinguish HCCs from mimickers on initial imaging examinations is crucial for appropriate management and treatment decisions. Therefore, this pictorial review presents the imaging findings of atypical HCCs and HCCs mimicking malignant and benign lesions and discusses important clues that may help narrow down the differential diagnosis.
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The aim of this study was to determine the rate, important findings, and risk factors related to discrepancies between on-call residents' and attending radiologists' interpretations of abdominal examinations. We identified 1132 eligible patients with abdominal radiology findings that were preliminary interpreted by on-call residents between February 2016 and September 2019. The preliminary interpretations were compared with the final interpretations by abdominal attending radiologists, including clinical data. The preliminary interpretations were analyzed by three radiologists in consensus, who categorized the reports according to organs, important findings (i.e., active bleeding, bowel obstruction, organ ischemia or infarction, and organ rupture), clinical outcomes, and discrepancies with respect to final interpretations. Multiple logistic regression analysis was used to evaluate the risk factors for important discrepant findings. Of 1132 patients, the bowel (n = 567, 50.1%) was the most common organ interpreted by on-call residents, followed by gallbladder/bile duct/pancreas (n = 139, 12.3%) and liver (n = 116, 10.2%). Of 1132, 359 patients (31.7%) had disease with 379 important findings: active bleeding (n = 222), organ rupture (n = 77), bowel obstruction (n = 52), bowel ischemia (n = 24), and organ infarction (n = 4). Sixty-four patients (5.6%) showed discrepancies, and 30 (2.6%) showed 32 important discrepant findings comprising 14 active bleeding, 10 bowel obstructions, 6 organ ruptures, and 2 cases of bowel ischemia. Of the 64 discrepant patients, 33 underwent delayed surgery (n = 18, 28.1%) or interventional treatment (n = 15, 23.4%). In multivariable analysis, bowel obstruction (adjusted odds ratio, 2.52; p = 0.049) was an independent risk factor for determining discrepancy between preliminary and final interpretations. The rate of overall and important discrepancies between on-call residents' and final interpretations was low. However, given that the bowel was the most frequently interpreted organ, bowel obstruction was identified as a risk factor for discrepant interpretations. The identified risk factor and findings may be useful for residents to minimize discrepancies.
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Internado y Residencia , Radiología , Traumatismos Torácicos , Competencia Clínica , Errores Diagnósticos , Humanos , Infarto , Radiología/educación , Factores de Riesgo , Tomografía Computarizada por Rayos XRESUMEN
Purpose: This study aimed to evaluate the natural growth of subepithelial tumors of the small bowel detected on CT. Materials and Methods: Consecutive patients who were suspected of having subepithelial tumors of the small bowel between January 2005 and December 2020 were reviewed. Eligible patients with suspected small (< 30 mm) subepithelial tumors on at least two CT evaluations were included in the analysis. The patients' data on demographic characteristics, tumoral characteristics, and tumoral size changes during the follow-up were collected. Results: This study included 64 patients with suspected small subepithelial tumors (n = 64) of the small bowel. After a median follow-up of 15.8 months, the diameter and volume growth rates were 0.02 mm/month and 1.5 mm3/month, respectively. A significant correlation was observed between the initial size and the growth rate of the small bowel subepithelial tumors. The group of large-sized tumors (initial diameter ≥ 10 mm) tended to show lobulated contours, heterogeneous enhancement, and necrotic changes more frequently than the group of small-sized tumors (initial diameter < 10 mm). Conclusion: Small bowel subepithelial tumors measuring less than 10 mm grew more slowly than those measuring 10-30 mm.
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PURPOSE: We aimed to analyze the prevalence, causes, and clinical settings of 4-year critical radiologic reports (CRRs) notified from the musculoskeletal section of the radiology department. Then, we investigated the communication outcomes. METHODS: This study was approved by our institutional review board. We retrospectively included 175 musculoskeletal CRRs from our database between January 2017 and December 2020. The CRRs were analyzed by two musculoskeletal radiologists, who categorized the CRRs by clinical setting (emergency department(ED) patient, outpatient, and inpatient), body part, type of image modality, reason for CRR, incidental lesion, and clinical outcome. The clinical outcome was retrieved from the electronic medical records. RESULTS: The 175 musculoskeletal CRRs accounted for 5.4% of the CRRs (n = 3217) available in the study period. Most CRRs (94.9%, 166/175) corresponded to the musculoskeletal system, while the remaining ones (5.1%, 9/175) corresponded to the non-musculoskeletal system. In addition, the spine, extremities, and thoracic cage accounted for 52.6%, 40.6%, and 1.7% of the musculoskeletal CRRs, respectively. Moreover, most patients presented to the ED (50.3%, 88/175), followed by inpatients (30.9%, 54/175), and outpatients (18.9%, 33/175). The CRR reasons included missed fracture (54.3%), suspected malignancy (16%), clinical emergency (10.3%), unexpected infection/inflammation (11.4%), and others (8%). Furthermore, 11 (6.3%) incidental lesions were not related to the primary imaging purpose. Referring clinicians actively acknowledged 80% of the CRRs. The loss to follow-up action was the highest in the ED patients (35.2%, 31/88; p < 0.001), being significantly higher than that in outpatients (6.1%, 2/33) and inpatients (3.7%, 2/54). CONCLUSION: Missed fractures were the most common cause of musculoskeletal CRRs. ED showed prevalence in musculoskeletal CRRs and reflected the highest loss to follow-up action. ED physicians should pay more attention to CRRs to enhance patient care.
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Sistema Musculoesquelético/diagnóstico por imagen , Servicio de Radiología en Hospital/tendencias , Comunicación , Diagnóstico por Imagen/estadística & datos numéricos , Diagnóstico por Imagen/tendencias , Registros Electrónicos de Salud , Estudios de Evaluación como Asunto , Fracturas Óseas/diagnóstico por imagen , Humanos , Evaluación de Programas y Proyectos de Salud , Radiografía/métodos , Radiología/métodos , República de Corea , Estudios Retrospectivos , Atención Terciaria de Salud , Centros TraumatológicosRESUMEN
Renal myxomas are very rare benign tumors. To date, a few cases have been reported in English literature, mostly in pathology and urology journals. Thus, there are few reports on the radiological findings associated with renal myxomas. We report on the imaging findings in a case of renal myxoma in a 62-year-old male. MRI demonstrated a well-defined mass in the left renal sinus, with intermediate high signal intensity on T2-weighted images and low signal intensity on T1-weighted images. The tumor showed gradual enhancement on contrast-enhanced T1-weighted images.
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OBJECTIVE: Sepsis is major determinants of prognosis in acute pyelonephritis (APN). This study aimed to assess factors associated with the development of sepsis among patients with clinically uncomplicated APN. SUBJECTS AND METHODS: We examined 463 patients presenting to our hospital without complications. We assessed clinical factors including demographic and laboratory features. Renal and extrarenal features on computed tomography (CT) were also analyzed. Risk factors of sepsis are assessed. RESULTS: The study included 361 patients without (78.0%) and 102 patients with sepsis (22.0%). Crude and attributable mortality rates were 3.9% and 2.0% versus 1.4% and 0.6%, respectively, among patients with and without sepsis. Clinical risk factors for sepsis were age >65 years (odds ratio [OR] 1.79, P = 0.02), absence of flank pain (OR 1.59, P = 0.04), absence of costovertebral tenderness (OR 1.89, P = 0.03), diabetes mellitus (OR 2.25, P = 0.02), bacteremia (OR 2.8, P = 0.01), C-reactive protein level >100 mg/L (OR 1.42, P = 0.02), and lack of previous APN history (OR 1.76, P = 0.04). APN grade IV (OR 3.16, P = 0.01), high grade hydronephrosis (OR 1.50, P = 0.03), diffuse peritoneal thickening (OR 4.12, P = 0.01), and acute interstitial pulmonary edema (OR 3.73, P = 0.01) were the CT features predictive of septic shock. CONCLUSIONS: Although uncomplicated APN was largely non-fatal, several clinical and CT features could lead to sepsis. Our findings may be useful for predicting sepsis risk and deciding whether intravenous antibiotic treatment and intensive management should be initiated for uncomplicated APN.
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Pielonefritis , Sepsis , Enfermedad Aguda , Anciano , Femenino , Humanos , Pielonefritis/diagnóstico por imagen , Estudios Retrospectivos , Sepsis/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Since 2019, ultrasound and magnetic resonance imaging for evaluation of urogenital disorders have been covered by the National Health Insurance (NHI) in Korea. Patients with urogenital malignancies were already insured by NHI for ultrasound and MRI. With the expansion of NHI coverage, patients with suspected prostate or gynecologic cancer, uterine fibroids before myomectomy and some other benign disease such as congenital anomaly can receive benefits of NHI. In consideration of these changes, radiologists and other clinicians should be aware of the indications and standard images of each examination and the required reporting forms. Clinical application based upon thorough understanding of the NHI guidelines will aid in improving the standard care of patients.
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PURPOSE: To evaluate radiation dose exposure, diagnostic performance, and image quality of low-dose and ultralow-dose abdominopelvic CT using the advanced modelled iterative reconstruction (ADMIRE) algorithm for focal lesion detection. METHODS: One hundred thirty-nine consecutive patients underwent contrast-enhanced abdominopelvic CT using a third-generation dual-source scanner to obtain three data sets with the following tube loads: 33.3% (ultralow-dose CT), 66.7% (low-dose CT), and 100% (standard-dose CT). The diagnostic performances of standard-dose CT, low-dose CT, and ultralow-dose CT for focal lesion detection and characterization in organs of the abdominopelvic cavity were analyzed by two readers and compared with the reference standard. Image quality was measured subjectively and objectively. RESULTS: Focal lesion detection showed 96.5-100% sensitivity and 97.7-100% accuracy in all representative organs on low-dose CT with acceptable image quality; it showed 87.4% sensitivity and 97.9% accuracy in the liver and 80.0% sensitivity and 88.2% accuracy in the rectal shelf on ultralow-dose CT with suboptimal image quality. Indeterminate lesions were significantly more common in the liver, pancreas, and kidneys on ultralow-dose CT than on low-dose CT. Enlarged lymph nodes showed 100% sensitivity and accuracy on ultralow-dose CT. Mean effective radiation doses of low-dose CT and ultralow-dose CT were 2.6 mSv and 1.3 mSv, respectively. CONCLUSIONS: The diagnostic performance of low-dose CT is similar to that of standard-dose abdominopelvic CT with acceptable image quality. Ultralow-dose CT cannot safely assess focal liver, pancreas, kidneys, and rectal shelf lesions but may be useful for the evaluation of enlarged lymph nodes.
Asunto(s)
Dosis de Radiación , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Algoritmos , Protocolos Clínicos , Femenino , Humanos , Hígado , Masculino , Persona de Mediana Edad , Exposición a la Radiación , CintigrafíaRESUMEN
OBJECTIVE: To compare the radiation dose and the objective and subjective image quality of 80 kVp and 80/150 kVp with tin filter (80/Sn150 kVp) computed tomography (CT) in oncology patients. METHODS: One-hundred-and-forty-five consecutive oncology patients who underwent third-generation dual-source dual-energy CT of the abdomen for evaluation of malignant visceral, peritoneal, extraperitoneal, and bone tumor were retrospectively recruited. Two radiologists independently reviewed each observation in 80 kVp CT and 80/Sn150 kVp CT. Modified line-density profile of the tumor and contrast-to-noise ratio (CNR) were measured. Diagnostic confidence, lesion conspicuity, and subjective image quality were calculated and compared between image sets. The effective dose and size-specific dose estimate (SSDE) were calculated in the image sets. RESULTS: Modified line-density profile analysis revealed higher attenuation differences between the tumor and normal tissue in 80 kVp CT than in 80/Sn150 kVp CT (127 vs. 107, P = 0.05). The 80 kVp CT showed increased CNR in the liver (8.0 vs. 7.6) and the aorta (18.9 vs. 16.3) than the 80/Sn150 kVp CT. The 80 kVp CT yielded higher enhancement of organs (4.9 ± 0.2 vs. 4.7 ± 0.4, P<0.001) and lesion conspicuity (4.9 ± 0.3 vs. 4.8 ± 0.5, P = 0.035) than the 80/Sn150 kVp CT; overall image quality and confidence index were comparable. The effective dose was reduced by 45.2% with 80 kVp CT (2.3 mSv ± 0.9) compared to 80/Sn150 kVp CT (4.1 mSv ± 1.5). The SSDE was 7.4 ± 3.8 mGy on 80/Sn150 kVp CT and 4.1 ± 2.2 mGy on 80 kVp CT. CONCLUSIONS: The 80 kVp CT reduced the radiation dose by 45.2% in oncology patients while showing comparable or superior image quality to that of 80/Sn150 kVp CT for abdominal tumor evaluation.